Disimpaction for Fecal Impaction: Procedure and Risks

Disimpaction is a procedure to treat fecal impaction caused by a large, hardened lump of stool (poop) stuck in the rectum. Chronic constipation can make passing stool difficult, leading to fecal impaction.

Depending on the severity of your case, a gastroenterologist (a doctor specializing in digestive conditions), registered nurse, or nurse practitioner may perform a disimpaction.

Disimpaction can provide relief from severe constipation. Addressing fecal impaction early on helps prevent complications, such as bowel perforation—when a large stool mass punctures the intestinal wall.

Disimpaction relieves severe constipation and fecal impaction by removing impacted stool you’re unable to pass with a normal bowel movement. Certain factors can increase your chances of having a fecal impaction, including:

Limited mobility: People with mobility limitations, such as those on extended bedrest or wheelchair users, are more likely to require disimpaction.
Neurological or nervous system disorders: Conditions like Parkinson’s disease, dementia, or spinal cord injuries that affect the nerves that control bowel movements can lead to fecal impaction.
Certain medications: Some medications can affect the signals sent between your nerves and muscles, leading to impaction. These include anticholinergics (e.g., antidepressants), narcotics (prescription pain medicines), and anti-diarrheal medication.
Age: Older adults are more likely to require disimpaction. Their digestive systems weaken as they age, and constipation becomes more common.

Successful disimpaction can relieve symptoms of fecal impaction, such as abdominal pain and cramping, bloating, and lower back pain. It can also relieve straining to pass stool and fluid leaking from the rectum.

Disimpaction sometimes reveals other issues, such as structural abnormalities in the intestines, tumors, or other digestive conditions. In these cases, additional treatment may be needed.

Healthcare providers can perform disimpaction in several ways. The severity of fecal impaction, the location of the stool mass within the rectum or large intestine (colon), and your overall health determine which type your healthcare provider will use. Here are four types of disimpaction:

Manual (Digital) Disimpaction

Manual disimpaction, or digital disimpaction, is the most common disimpaction procedure. Your provider inserts a gloved, lubricated finger into your rectum to break up and remove impacted stool in smaller pieces.

Manual disimpaction is performed in small steps to avoid injury to your rectum. Your provider may also put a suppository into your rectum to help soften and clear the stool.

Enema-Based Disimpaction

Enema-based disimpaction involves inserting a laxative fluid into your rectum and colon to soften and loosen the stool, making it easier to pass.

A healthcare provider typically inserts a Foley catheter—a flexible tube with a balloon at its tip—to dispense the fluid. They inflate the balloon to hold the catheter in place and ensure the enema solution goes into your colon.

After administering the enema, they may gently massage your lower abdomen to help move your bowels and eliminate the stool.

Endoscopic Disimpaction

If the fecal impaction is higher in the colon, your healthcare provider may perform an endoscopic procedure. This involves inserting an endoscope (a thin, flexible tube with a camera) into the rectum. An endoscopic disimpaction allows them to see and break up the blockage using small instruments through the endoscope.

Surgical Disimpaction

Surgical disimpaction is a more invasive procedure reserved for extreme cases of fecal impaction when other methods are ineffective. It may also be used if there is a risk of complications (e.g., bowel perforation) or if you have symptoms of complications, such as peritonitis (inflammation of the abdominal lining).

Surgical disimpaction involves a surgeon making an incision in your abdomen. They can access and remove the impacted stool directly from your colon through the incision.

Disimpaction is usually performed in a clinical setting, either in your healthcare provider’s office or the hospital. The procedure is straightforward but can be uncomfortable. Understanding what to expect and being prepared can help ease anxiety and ensure the process goes smoothly.

Clothing

When preparing for a disimpaction procedure, wear comfortable, loose-fitting clothing. You will need to remove your pants and underwear and may need to change into a hospital gown before the procedure begins.

Eating and Drinking

Fasting requirements vary depending on the type of disimpaction procedure. For a manual disimpaction, you may not need to fast. Your healthcare provider may also ask you to eat or drink about 30 minutes before the procedure to stimulate a bowel movement.

Depending on the type of disimpaction you need, your healthcare provider may ask you to fast for a specific number of hours before the procedure.

Medication

Inform your healthcare provider about any medications you are currently taking. You can typically continue to take your medications as prescribed, but there might be exceptions. It’s important to talk to your healthcare provider before the procedure.

Your healthcare provider may ask you to drink an oral laxative solution, such as MiraLAX (polyethylene glycol), before a manual disimpaction. This helps soften the stool before the procedure.

Documents and Personal Support

Bring the required documents to your appointment, including your identification (ID) card, insurance card, and relevant medical records.

Ask your healthcare provider if you can bring a support person to your appointment if you need one. Whether they can be in the room with you during the procedure depends on the type of disimpaction and the facility’s visitor policies, so check with your provider beforehand.

Insurance and Financial Considerations

Most health insurance plans cover disimpaction procedures that are considered medically necessary. Check with your insurance provider about your policy’s coverage details and determine what out-of-pocket expenses you can expect, such as co-pays and deductibles.

If you are uninsured or concerned about the cost, discuss payment options with your healthcare provider’s office or the hospital staff beforehand. Some hospitals and clinics offer financial assistance programs to help with medical expenses.

Manual disimpaction is routine, but it’s normal to feel vulnerable before and during a disimpaction procedure. It may help to remind yourself that your healthcare provider is experienced and will prioritize your dignity and comfort.

During the Procedure

You may feel some discomfort during a manual disimpaction. Your healthcare provider may offer sedation to help you relax. Here’s what to expect during a manual disimpaction:

You will sit on a toilet or lie on your left side on an examination table.
The healthcare provider gently inserts a gloved and lubricated finger into your rectum.
They will then palpate (feel) the impacted stool by moving their finger in a circular motion to break it into smaller pieces and manually remove it.
They will repeat this process until the stool is completely removed.
They will encourage you to communicate throughout the procedure so you can ask questions or express any discomfort you might be experiencing.

The steps for an enema-based disimpaction are as follows:

You will lie on your side on an examination table.
Your healthcare provider will insert a catheter or enema nozzle into your rectum and release the liquid to soften the stool. Although you may experience some discomfort, you will be awake and able to communicate with your provider throughout the procedure.
You will continue lying on your side for approximately 10 minutes before the catheter or enema nozzle is removed.
You will get up and sit on a toilet for 30-45 minutes until your colon is empty.
The enema procedure may be repeated if the first attempt does not completely remove the impacted stool.

Endoscopic and surgical disimpaction procedures are performed in hospitals. To reduce discomfort during these procedures, you will be sedated or under general anesthesia.

In an endoscopy, your healthcare provider will insert an endoscope into your rectum to remove the impacted stool. In surgery, they will make an incision in your abdomen to remove the impacted stool.

After the Procedure

Most people feel almost immediate relief from constipation and impaction symptoms after a manual disimpaction. It is an outpatient procedure, meaning you can go home afterward. You may have some temporary cramping or rectal discomfort.

Your healthcare provider will likely recommend lifestyle modifications to prevent constipation and future impactions. For instance, you may need to increase your water intake, eat a high-fiber diet, and exercise.

The frequency of disimpaction procedures varies depending on the underlying cause of the impaction. For chronic conditions, such as spinal cord injuries, regular manual disimpaction may be necessary to prevent complications.

Disimpaction is generally a safe procedure, but there are some potential risks, including:

Discomfort and pain: While lubrication and sedation can help lessen your discomfort, you may have rectal cramping or pain during a manual disimpaction.
Rectal bleeding: Minor rectal bleeding is possible if a hard stool causes any anal fissures (small tears) in the rectal lining.
Cardiac arrest: In rare cases, disimpaction can trigger bradycardia (slow heart rate) and lead to cardiac arrest (when the heart stops beating). This happens because rectal manipulation can stimulate the vagus nerve, which can slow down your heart rate too much. This risk is very rare and most often occurs in older adults with chronic illnesses.

Most people can safely undergo disimpaction, but older adults with chronic conditions may require additional precautions. Your healthcare provider will discuss the risks, benefits, and alternative methods for treating fecal impaction.

Contact your healthcare provider if you have any of the following symptoms after disimpaction:

Ongoing pain or discomfort
Regular constipation
Rectal bleeding
Bloody stool

Disimpaction can give you rapid relief from constipation and fecal impaction. Most people feel relief from discomfort and bloating within minutes of successful disimpaction. Your healthcare provider may recommend further testing, such as a colonoscopy, to better understand the underlying cause of your constipation, especially if it’s chronic or recurring.

Following disimpaction, your healthcare provider will likely recommend lifestyle changes to prevent future constipation. This might involve dietary changes, increasing fiber intake, using stool softeners, or taking medications to promote regular bowel movements.

Disimpaction is a medical procedure that removes impacted stool stuck in the rectum. It is a treatment for severe constipation and provides immediate relief.

Depending on the severity and location of the impaction, your healthcare provider may recommend a specific type of disimpaction. The most common method is manual disimpaction, where a provider inserts a gloved finger to break up and remove the stool.

Disimpaction is generally a safe procedure with minimal risks, but discuss your concerns with your provider beforehand.

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